Department of the Treasury
Posted on May 29, 2013
A joint rule released by the US Department of Labor (DoL), the US Department of the Treasury (DoT), and the US Department of Health and Human Services (HHS) addresses new provisions regarding participatory wellness programs in the workplace. Workplace wellness programs are designed to reduce the prevalence of chronic disease, stifle growing health care costs, and improve overall health by rewarding employees for participating in certain activities, such as educational classes or obtaining memberships to fitness centers. The final rule sets the maximum reword for completion of a nondiscriminatory health-contingent wellness program to 30% of coverage costs, up from the original 20%. Employees that successfully complete tobacco-related wellness programs are eligible for up to 50% of cost of coverage.
Posted on May 14, 2013
According to a proposed rule released by the Internal Revenue Service (IRS), “activities that improve health quality” can not be used to determine Blue Cross and Blue Shield’s Medical Loss Ratio (MLR) in regards to obtaining their tax-exempt status. According to the Affordable Care Act (ACA), insurance companies lose their tax privilege under tax code Section 833 and the MLR if they do not spend 85% of their premium revenue on enrollee medical services. Until this proposed rule was released, interim guidance permitted insurance companies to count health care quality activities toward their 85%.
Posted on April 30, 2013
The Internal Revenue Service (IRS) issued a proposed rule discussing the minimum value of employer-sponsored health coverage and the ability of employees to receive premium assistance tax credits. According to the proposed rule, IRS states that the minimum value would be determined by dividing the cost of certain benefits to the standard population by the cost of all benefits for the population, including employee cost-sharing and plan payments, and converting that value to a percentage. Several values, such as the amount contributed by employer’s to health savings accounts, will be considered in determining the employer’s share of costs. However, IRS has also proposed that employer contributions to wellness incentive programs does not count toward health plan minimum value. Additionally, the proposed rule also states that employee-sponsored large group plans are not beholden to every essential health benefit category (EHB), nor must they design their plans to mimic the EHB standards that apply to qualified health plans offered in the Exchange. Adherence to the minimum value requirements will prevent employers from paying the employee shared responsibility payment penalties and will render their employees ineligible for premium assistance tax credits in the Exchange.
Posted on April 30, 2013
In the 15th set of Affordable Care Act (ACA) FAQs, the Internal Revenue Service (IRS) and the Employee Benefit Security Administration (EBSA) answer questions posed by the public and stakeholders to demystify the implementation of various components of the ACA. This particular set discusses annual limit waivers, stating that an alteration to a health plan or policy year will not impact the expiration of an annual limit waiver. The FAQs also indicate that IRS, EBSA and the US Department of Health and Human Services (HHS) will not issue guidance on provider nondiscrimination prior to January 1st, 2014, because the statutory language on the topic is “self-implementing.” In regards to transparency reporting, the FAQs clarify that plans are not beholden to the transparency provisions of the ACA until the plans have been certified as a qualified health plan (QHP) for one benefit year.
Posted on April 3, 2013
The Affordable Care Act (ACA) mandates that charitable hospitals perform community health needs assessments (CHNA). The proposed rule released by the Internal Revenue Service (IRS) provides guidance on specific components of the CHNA, including related excise tax and reporting obligations, as well as clarification on consequences of failing to meet CHNA and other requirements.
Posted on March 19, 2013
A proposed rule issued yesterday by the US Department of Labor, US Department of Treasury, and the US Department of Health and Human Services (HHS) implements a provision in the Affordable Care Act (ACA) that requires employer-sponsored health plans to be activated for employees within 90 days. In addition, employers cannot require employees to accrue a minimum number of hours before the 90 day wait period starts. The rules specifically state the 90 day wait limit in and of itself is not an employer mandate.
Comments on the proposed rules will be due by May 20, 2013.
Posted on March 18, 2013
In a guidance issued Friday, the US Department of Health and Human Services (HHS), US Department of Labor, and US Department of the Treasury extended the interim standards for state external review processes. These standards are meant to make health care claim denials easier for patients to appeal, as set forth in the Affordable Care Act (ACA). Under the new guidance, health insurance issuers will be deemed compliant as long as their external review processes meet the National Association of Insurance Commissioner (NAIC) interim process standards established by Technical Release No. 2011-02. The transitional period expires January 1, 2016, and issuers will then have to meet the standards from the July 2010 regulations issued by the federal government.
Posted on March 7, 2013
The US House of Representatives approved a continuing resolution (CR) yesterday that would deny necessary funding for several agencies to implement their respective portions of the Affordable Care Act (ACA). The bill, H.R. 933, was introduced on Monday by Appropriations Committee Chairman Hal Rogers (R-KY). Several specific funding denials include:
- $949 million to the US Department of Health and Human Services (HHS) to aid in paying for the federal insurance exchanges.
- $29 million to the Centers for Medicare and Medicaid Services (CMS) for Health Care Fraud and Abuse Control.
- Funds requested by the Internal Revenue Service (IRS) for ACA tax provisions.
267 Members voted in favor of the bill.
Posted on March 1, 2013
The US Department of Health and Human Services (HHS) has released a flurry of regulations implementing various aspects the Affordable Care Act (ACA) today, including insurance market rules and rules related to the small business exchanges (SHOP). Additionally, both the Internal Revenue Service (IRS) and the Office of Personnel Management (OPM) have released ACA regulations. A list of the rules is…
Posted on February 20, 2013
The Departments of Labor, Health and Human Services (HHS) and Treasury have jointly prepared a new set of Frequently Asked Questions (FAQs) regarding implementation of various provisions of the Affordable Care Act (ACA). The twelfth installment of the set, these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended. This round of FAQs covers cost-sharing limitations and coverage of preventive services. The FAQs state that employers cannot limit contraceptive coverage to oral contraceptives only. The Obama administration also specifies that over-the-counter contraceptives that are FDA-approved and prescribed by a doctor are included as required coverage.